Understanding the Texas Measles Outbreak: Causes, Symptoms, and Prevention

The United States is currently grappling with a significant public health concern as Texas experiences its largest measles outbreak in 30 years. With 90 confirmed cases and counting, the situation is dire, especially given that most of the cases involve children. This outbreak has raised questions about the spread of measles, its severity, and the role of vaccinations in preventing it. Below, we break down the key aspects of the outbreak, answer common questions, and provide essential information to help individuals understand and protect themselves against measles.

How the Texas Measles Outbreak Unfolded

The measles outbreak in Texas has reached alarming proportions, with 90 cases reported as of the latest update. Of these, 32 cases were added in just a few days, indicating a rapid spread. Sixteen patients have been hospitalized, and the majority of cases are among children aged 5 to 17. The outbreak is concentrated in Gaines County in West Texas, where 57 cases have been reported. Surrounding counties, including Terry, Dawson, Yoakum, Lubbock, Lynn, and Ector, have also been affected, with the virus spreading farther into Dawson and Ector counties.

Just across the state line in New Mexico, Lea County has reported nine measles cases. While no direct link between the Texas and New Mexico outbreaks has been confirmed, officials note that residents of Gaines County often travel to New Mexico for shopping, raising concerns about cross-border transmission. Health experts warn that the highly contagious nature of measles means the outbreak could continue to grow, emphasizing the urgent need for awareness and prevention measures.

How Measles Spreads

Measles is one of the most contagious viruses known, spreading through respiratory droplets when an infected person coughs, sneezes, or even breathes. The virus can linger in the air or on surfaces for up to two hours after the infected person has left the area. Unvaccinated individuals are particularly vulnerable, with one infected person capable of spreading the virus to up to 9 out of 10 close contacts.

What makes measles especially challenging is that it can spread even before symptoms appear. An infected person can transmit the virus from four days before the characteristic rash develops to four days after it appears. This means that by the time someone realizes they have measles, they may have already infected others.

Has Measles Become More Virulent?

Contrary to concerns, the measles virus itself has not become more virulent over time. However, its potential for severe complications is often underestimated. According to Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center, the average person may not be aware of the severity of measles because its complications are relatively rare but serious.

Measles symptoms typically include the "three Cs": cough, coryza (a runny nose), and conjunctivitis (red eyes). Other symptoms include a high fever (which can reach over 104 degrees Fahrenheit), a red blotchy rash, and Koplik spots (small white spots that may appear inside the mouth). In severe cases, measles can lead to blindness, deafness, pneumonia, or swelling of the brain (encephalitis). Globally, measles still claims millions of lives, particularly in areas with low vaccination rates.

In the U.S., measles was declared eliminated in 2000, but cases still occur, often linked to unvaccinated travelers. The last measles-related death in the U.S. was reported in 2015. Despite its relatively low mortality rate in developed countries, measles remains a dangerous disease, especially for young children and those with weakened immune systems.

Why Vaccination Rates Are Low in Some Areas

Low vaccination rates in parts of Texas and New Mexico are a significant factor in the current outbreak. In Gaines County, where the majority of cases are concentrated, nearly one in five incoming kindergartners did not receive the measles, mumps, and rubella (MMR) vaccine in the 2023-24 school year. Other affected counties also fall below the U.S. Department of Health and Human Services’ goal of 95% vaccination coverage, which is critical for preventing outbreaks of highly contagious diseases like measles.

Nationwide, MMR vaccine coverage is declining, with the U.S. falling short of the 95% threshold for four consecutive years. This downward trend is attributed to increasing vaccine hesitancy and exemptions. For example, over 125,000 kindergartners in the U.S. were exempt from at least one state-mandated vaccine in the last school year. These declining vaccination rates have contributed to the rise in measles cases, with 285 cases reported in 2023—the highest number since 2019.

Vaccination Schedule and Effectiveness

The Centers for Disease Control and Prevention (CDC) recommends that children receive two doses of the MMR vaccine: the first between 12 and 15 months of age and the second between 4 and 6 years old, just before starting school. These two doses provide lifelong immunity for most people.

The vaccination schedule is determined by the CDC’s Advisory Committee on Immunization Practices, along with the American Academy of Pediatrics and the American Academy of Family Physicians. During an outbreak, health departments may issue updated guidance, such as recommending earlier vaccination for children in affected areas. For example, the Texas health department has advised residents of Gaines County to expedite their second dose of the MMR vaccine if they are eligible.

Adults who are not immune should also get vaccinated, with the second dose administered 28 days after the first. Pregnant women cannot receive the MMR vaccine, but they can receive immunoglobulin if exposed to measles.

Protecting Unvaccinated Children and Addressing Concerns

For parents of young children, especially those too young to be vaccinated, the risks of measles are daunting. Infants under 6 months of age are not eligible for the MMR vaccine, but they may still have some protection from antibodies passed from their mother during pregnancy. However, if exposed to measles, these infants are at a higher risk of severe illness.

In such cases, immunoglobulin—a treatment that provides temporary antibodies—can be administered up to six days after exposure to reduce the severity of the illness. Meanwhile, parents of unvaccinated children are urged to avoid public places where measles is spreading and to ensure high levels of community vaccination to create "herd immunity," which protects vulnerable individuals.

For vaccinated individuals, the risk of contracting measles is low, but not zero. Two doses of the MMR vaccine are about 97% effective, but as the virus spreads, even vaccinated people may be at risk. However, symptoms are typically milder, and the likelihood of spreading the virus is reduced.

In conclusion, the measles outbreak in Texas serves as a stark reminder of the importance of vaccination and community immunity. While measles has not become more virulent, its complications can still be deadly, especially for young children and unvaccinated individuals. By understanding how measles spreads, staying informed about vaccination schedules, and taking proactive steps to protect ourselves and our families, we can work together to prevent further outbreaks and safeguard public health.